Integrative review of the literature on hospitalizations of older people for conditions sensitive to Primary Care in Brazil

Montilla, Dalia Romero; Souza, Nathalia Andrade de; Carvalho, Vinícius de Souza Silva; Marques, Aline Pinto; Almeida, Gabriela Nayara Nascimento; Sales, Jonathan de Freitas

doi:10.1590/1413-812320242911.16402023

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REVIEW ARTICLE • Ciênc. saúde coletiva 30 (suppl 1) • 2025 • https://doi.org/10.1590/1413-812320242911.16402023EN linkcopy

Integrative review of the literature on hospitalizations of older people for conditions sensitive to Primary Care in Brazil

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Abstract

Hospitalizations for ambulatory care sensitive conditions (ACSCs) are preventable with adequate primary care (PC). For the elderly population, they are important due to their greater vulnerability to chronic diseases and comorbidities. Objective: to carry out an integrative review of articles on ACSCs in the elderly and their correlation with indicators of access to primary care. The research was carried out on the BVS and PUBMED databases. Inclusion criteria: relationship between ICSAP and PA, publications from 2000 to 2022, analysis of the elderly age group, statistical methods, Portuguese, Spanish or English languages and indexing in peer-reviewed journals. We identified 315 publications and selected 15, 12 of which focused on the elderly population. The South and Southeast regions were the most analyzed, and the year most investigated was 2012. Coverage of the Family Health Strategy was the most commonly used indicator. A reduction in ACSC rates in the elderly was positively correlated with access to PHC. Monitoring ACSCs is an important tool for managing the health of the elderly, with PH playing a strategic role in reducing hospitalizations, minimizing risks and promoting healthy ageing.

Keywords:
Ambulatory Care Sensitive Conditions; Hospitalization; Review; Aged; Health Status Indicators

Title/author	Objective	Study design	Age range	Scope/Period	Main evidence
Tendência temporal das internações por condições sensíveis à atenção primária em idosos no Brasil. Knabben et al., 2022	A time trend analysis of HACSCs among older adults, by structure, magnitude and causes.	Time series ecological study	60-64; 65-69; 70-74;75-79;80+	Brazil/ 2000-2018	Decrease in HACSCs among older adults; less heart failure, more pneumonia. Increase in appointments, ESF coverage correlated negatively with HACSCs.
Análise espacial dos fatores associados às internações por condições sensíveis à atenção primária entre idosos de Minas Gerais. Silva et al., 2021	To determine the variability of HACSC in the older adult population of Minas Gerais state and analyse the determinants of occurrence.	Spatial analysis ecological study	60-79	Minas Gerais/2014	Per capita income and ESF coverage were linked to lower HACSC rates. Unfavourable sociodemographic indicators meant municipalities in the Northeast were at high risk.
Impacto da qualidade da atenção primária à saúde na redução das internações por condições sensíveis. Castro et al., 2020	To investigate the association between number of HACSCs and PHC quality in Brazilian municipalities.	Ecological study	<5; 5-59; 60+	Brazil/2014	Coefficient of HACSCs among older adults was about six times higher than in the population from 5 to 59 years old. Municipalities with more older adults and social vulnerability returned higher rates of HACSC.
Determinantes sociais em saúde e internações por insuficiência cardíaca no Brasil. Albuquerque et al., 2020	To examine the relation between social determinants of health and hospitalisations for heart failure in Brazil.	Retrospective ecological study	60+	Brazil/ 2008-2016	Regression model found that ESF coverage and federal funding for PHC reduced HACSCs.
Causes for hospitalization of elderly individuals due to primary care sensitive conditions and its associated contextual factors. Soares et al., 2019	To examine HACSCs and associated contextual factors among older adults residing in the Northeast.	Descriptive ecological study	60+	Northeast/ 2010-2015	The most common causes of HACSCs in older adults were: heart failure (89,096), cerebrovascular diseases (75,011) and gastrointestinal diseases (73,705).
Internações por condições sensíveis à atenção primária no estado de Rondônia: estudo descritivo do período 2012-2016. Santos et al., 2019	To describe the frequency of, and reasons for, HACSCs in Rondônia and analyse their relation with change in ESF coverage.	Descriptive ecological study	0-4; 5-9; 10-19; 20-49; 50-100	Rondônia/ 2012-2016	HACSC rates were high in Rondônia, but decreased steadily with increasing ESF coverage.
Fatores associados às internações por hipertensão arterial. Dantas et al., 2018	To study hospitalisations for arterial hypertension and associated factors over time.	Descriptive ecological study	<60 anos e 60+	Brazil/ 2010-2015	Higher prevalence of hospitalisations in the over 60s (around 59.3%) in all regions of Brazil.
Internações por condições sensíveis à atenção primária em Minas Gerais, entre 1999 e 2007. Oliveira et al., 2017	To examine HACSC rates in Minas Gerais	Time trend ecological study	20-79	Minas Gerais/ 1999-2007	Significant reduction in HACSCs during the period. Two of the regions that performed worst returned unfavourable socioeconomic indicators.
Impacto da estratégia saúde da família nas internações hospitalares por condições sensíveis à atenção primária. Tagliari et al., 2017	To correlate HACSC rates and introduction of the ESF in the municipality of Passo Fundo.	Time trend ecological study	<1; 1-4; 5-14; 15-24; 25-34; 35-44; 45-54; 55-64; 65+	Passo Fundo, Rio Grande do Sul/ 1998-2007	Introduction of the ESF in Passo Fundo reduced HACSC rates in all age groups: rates in the over-65s are similar to those among the under one year olds.
Panorama das internações por condições sensíveis à atenção primária no Espírito Santo, Brasil, 2000 a 2014. Pazó et al., 2017	To describe the time series of HACSCs, by sex, age group, size of municipality and cause groups and to investigate associated factors.	Time series ecological study	0-4; 5-9; 10-14; 15-19; 20-29; 30-39; 40-49; 50-59; 60-69; 70-79; 80+	Espírito Santo/ 2000-2014	Annual change in HACSC rates in the older adult population during the period was: −5.00% (60-69 years), −3.81% (70-79 years) and −2.79% (80 or more years).
Diminuição de internações por condições sensíveis à Atenção Primária em idosos no estado do Paraná. Previato et al., 2017	To examine HACSCs in older adults in Paraná state, by causes and ESF coverage.	Descriptive ecological study	60-74	Paraná/ 2000 e 2012	HACSCs in older adults declined in Paraná between 2000 and 2012, reflecting improved socioeconomic conditions over the study period.
Estrutura e processo de trabalho na atenção primária e internações por condições sensíveis. Araujo et al., 2017	To investigate whether the structural characteristics of primary health care facilities and the PHC team work process are associated with the number of HACSCs.	Ecological study	<5; 60+	5,565 Brazilian unicipalities/2012	Indicators of HACSCs were related positively with improved health service coverage in recent years.
Condições socioeconômicas, oferta de médicos e internações por condições sensíveis à atenção primária em grandes municípios do Brasil. Castro et al., 2015	To examine variables associated with HACSCs in Brazilian municipalities with populations of less than 50,000.	Exploratory descriptive analysis in time series and ecological study	Total	Brazil/ 1998-2012	From 1998 to 2012, HACSCs decreased by 15% in Brazil, while ESF coverage increased by 700% and availability of doctors increased by approximately 16%.
Modelagem hierárquica de determinantes associados a internações por condições sensíveis à atenção primária no Espírito Santo, Brasil. Pazó et al., 2014	To investigate the association between socioeconomic determinants and HACSCs and between availability of infrastructure and health service coverage with HACSCs.	Descriptive ecological study	0-19; 20-64; 65+	Espírito Santo/ 2010	Urbanisation, illiteracy and SUS beds were related positively with HACSCs. HACSC rates were higher in medium-sized municipalities.
Internação de idosos por condições sensíveis à atenção primária. Marques et al., 2014	To examine change in HACSCs of older adults over time, by structure, magnitude and causes.	Cross-sectional study	60-64; 65-69; 70-74. 75+ excluded	Rio de Janeiro/ 2000-2010	HACSCs decreased over the study period. ESF coverage increased from 3.6% in 2000 to 23.6% in 2010. Medical appointments for older adults increased from 90 to 420 per 1,000 population between 2000 and 2010.

Title	HACSC categorisation	PHC indicators used to correlate with HACSCs	Source	Correlation method	Study findings
Tendência temporal das internações por condições sensíveis à atenção primária em idosos no Brasil	Total HACSCs and HACSCs by main causes	ESF coverage / PHC appointments for older adults	SIAB	Pearson correlation	A significant negative relationship between HACSCs and ESF coverage and with PHC appointments for older adults.
Análise espacial dos fatores associados às internações por condições sensíveis à atenção primária entre idosos de Minas Gerais	Total HACSCs	ESF coverage / Number of SUS beds per unit population	CNES	Bayesian multivariate regression analysis	Each extra bed per 1,000 population increased HACSC rate by an average 2.8%, while 10% additional ESF coverage reduced HACSC rates by an average 4.2%.
Impacto da qualidade da atenção primária à saúde na redução das internações por condições sensíveis	Total HACSCs	ESF coverage / Number of SUS beds per unit pop./ Quality of municipal primary care	SIAB; CNES; PMAQ-AB	Two-block hierarchical analysis	HACSC rates increased with number of beds, ESF coverage and better quality PHC.
Determinantes sociais em saúde e internações por insuficiência cardíaca no Brasil	Cardiac failure - CID 10: I50	ESF coverage	Primary Care Department (DAB)	Regression model	HACSCs decreased with ESF coverage
Causes for hospitalization of elderly individuals due to primary care sensitive conditions and its associated contextual factors	Total HACSCs	Primary care coverage / Number of primary care appointments	SIAB	Spearman correlation	No significant correlation was found between HACSCs and primary care coverage, nor between HACSCs and PHC appointments for older adults.
Internações por condições sensíveis à atenção primária no estado de Rondônia: estudo descritivo do período 2012-2016	Total HACSCs and HACSCs by main causes	ESF coverage	Primary Care Department (DAB)	Spearman correlation	Slight reduction in HACSCs between 2012 and 2016 and, at the same time, a gradual increase in ESF coverage, which was 60.4% in 2012 and 71.3% in 2016.
Fatores associados às internações por hipertensão arterial	Essential arterial hypertension (EAH) - CID 10: I10	Rate of cardiologists in PHC and UNDP social development indicators.	SIAB e PNUD	Pearson correlation	Hospitalisations for EAH are positively related to cardiologists, Gini index, per capita income and municipal HDI and negatively to illiteracy.
Internações por condições sensíveis à atenção primária em Minas Gerais, entre 1999 e 2007	Total HACSCs and HACSCs by main causes	ESF coverage	Primary Care Department (DAB)	Pearson correlation	Strong negative correlation between HACSC rates and a ESF coverage.
Impacto da estratégia saúde da família nas internações hospitalares por condições sensíveis à atenção primária	Total HACSCs	ESF coverage	SIAB	Simple linear regression analysis	Strong negative correlation between HACSC rates and a ESF coverage.
Panorama das internações por condições sensíveis à atenção primária no Espírito Santo, Brasil, 2000 a 2014	Total HACSCs	ESF coverage/ Number of SUS hospital beds / Doctors per unit population / Socioeconomic indicators	Primary Care Department (DAB), UNDP, IPEA and CNES	Multivariate regression analysis	Positive correlations between HACSC rates and ESF coverage and doctors per unit population. Very strong, positive correlation between HACSC rates and number of beds.
Diminuição de internações por condições sensíveis à Atenção Primária em idosos no estado do Paraná	Total HACSCs and HACSCs by main causes	ESF coverage	SIAB	Pearson correlation	Very strong, negative correlation between ESF coverage and HACSC rates.
Estrutura e processo de trabalho na atenção primária e internações por condições sensíveis	Total HACSCs	Coverage by family allowance programme (PBF), community health workers strategy (EACS) and family health strategy.	SIAB	Negative binomial regression coefficient	2013: HACSCs correlated negatively with family allowance and positively with community health worker and family health strategy coverage. 2014: HACSCs correlated negatively with family allowance and positively with community health worker and family health strategy coverage.
Condições socioeconômicas, oferta de médicos e internações por condições sensíveis à atenção primária em grandes municípios do Brasil	Total HACSCs	ESF coverage / Supply of doctors / SUS hospital beds	SIAB, MS, SAS e DAB	Pearson correlation	Positive correlation between family health strategy coverage and HACSC rates in the Southeast. Proporção de leitos SUS correlated positively in the North and Northeast. Supply of doctors correlated positively in the South.
Modelagem hierárquica de determinantes associados a internações por condições sensíveis à atenção primária no Espírito Santo, Brasil.	Total HACSCs	Family health strategy (ESF) coverage / Accelerated growth programme (PACS) coverage / Number of doctors / SUS hospital beds / Socioeconomic and cioenvironmental indicators	SIAB / CNES / AMS	Multivariate Poisson analysis with backward method	At 65 years of age, HACSC rate correlated positively with ESF and PACS coverage and with SUS hospital beds, but negatively with number of doctors.
Internação de idosos por condições sensíveis à atenção primária	Total HACSCs and HACSCs by main causes	ESF coverage /	SIAB	Pearson correlation	Negative correlation between HACSCs and ESF coverage, and moderate negative correlation between HACSCs and number of appointments for older adults.

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